What is the Stereotactic Brain Biopsy Procedure? - Aaron Cohen-Gadol, M.D.

Summary

In this informative video, neurosurgeon Aaron Cohengador discusses stereotactic brain biopsy, a minimally invasive procedure to diagnose brain tumors. He explains the process, indications, and benefits, highlighting its accuracy and safety. The video covers pre- and post-operative care, potential complications, and emphasizes the biopsy's role in effective treatment planning for patients with brain tumors.

Takeaways

• 🧠 Stereotactic brain biopsy is a procedure to obtain a small piece of tumor tissue for microscopic analysis to confirm the type of tumor.
• 📍 It is indicated when a tumor cannot be safely removed or its location makes complete resection impossible, to help confirm the tumor's nature for alternative treatments.
• 🔍 The biopsy provides exact diagnosis of unidentified masses found on imaging like MRI, aiding in understanding the tumor's type and aggressiveness.
• 🏥 The procedure is minimally invasive, using a coordinate-based navigation system to accurately target the tumor location within the brain.
• 🛠️ There are two types of stereotactic biopsy systems: framed, which is more accurate but requires a head frame, and frameless, which is more comfortable for patients.
• 👨‍⚕️ A neurosurgeon performs the biopsy, often recommended by an oncologist, neurologist, or when the neurosurgeon deems tumor removal unsafe.
• 🧬 The tissue sample is sent to a pathologist for examination under a microscope, which is critical for determining the tumor's characteristics and diagnosis.
• ⏱️ Results of the biopsy may take up to a week to be reported back to the healthcare team for further analysis and treatment planning.
• 🚫 Before the biopsy, patients must stop blood thinners and non-steroidal anti-inflammatory drugs to minimize bleeding risks.
• 🛌 The procedure is typically done under general anesthesia, is relatively short, and requires an overnight hospital stay with post-operative care instructions.
• 🚨 Complications from the biopsy are rare but can include bleeding in the brain, which may cause new neurological symptoms and require immediate attention.
• 🏆 The outcomes of a stereotactic brain biopsy are usually favorable, with patients often returning to normal activities within a week and achieving a realistic and accurate diagnosis.

Q & A

What is a stereotactic brain biopsy?

A stereotactic brain biopsy is a procedure to obtain a small piece of tissue from a brain tumor for further microscopic analysis by a pathologist to determine the exact type and aggressiveness of the tumor.

Why is a stereotactic brain biopsy performed?

It is performed when a tumor cannot be safely removed, or its location makes complete resection impossible, to confirm the type of tumor so that alternative treatments can be designed.

How does a stereotactic brain biopsy help in treating brain tumors?

It helps by providing a definitive diagnosis, which allows the healthcare team to design the most effective treatment plan that may include non-surgical options.

What are the indications for a stereotactic biopsy?

The indications include determining the exact diagnosis of an unidentified mass found on imaging, such as an MRI, to understand the type and aggressiveness of the tumor.

What types of stereotactic biopsy systems are mentioned in the script?

The script mentions two types: framed stereotactic biopsy, which requires a frame placed on the patient's head, and frameless stereotactic biopsy, which uses a GPS-like system for navigation without the need for a frame.

Who typically performs a stereotactic brain biopsy?

A neurosurgeon with expertise in the procedure performs a stereotactic brain biopsy, often after consultation with an oncologist, internal medicine doctor, or neurologist.

What happens to the tissue sample obtained during a stereotactic brain biopsy?

The tissue sample is sent to a pathologist or neuropathologist for examination under a microscope to confirm the diagnosis and assess the tumor's characteristics.

How long does it take to receive the results of a stereotactic brain biopsy?

It may take up to a week for the biopsy results to be processed and returned to the patient's healthcare team.

What are the potential complications of a stereotactic brain biopsy?

Complications are rare but can include bleeding in the brain, which may cause new neurological symptoms. The procedure is considered extremely safe, with a 95% safety rate.

What are the post-operative care instructions after a stereotactic brain biopsy?

Patients are advised to avoid strenuous activities, not to drink alcohol or use nicotine products, take walks, sleep with the head elevated, and follow specific care instructions for the incision site.

What should a patient do if they experience certain symptoms after a stereotactic brain biopsy?

If a patient experiences fever, chills, confusion, severe headaches, swelling, bleeding, or increased pain at the incision site, they should inform their surgeon immediately.

Outlines

00:00

🧠 Introduction to Stereotactic Brain Biopsy

Dr. Aaron Cohen Gadol introduces himself as a neurosurgeon with extensive experience in brain tumor management. He discusses the stereotactic brain biopsy, a procedure to obtain a small tissue sample from a brain tumor for microscopic analysis. The biopsy is crucial when a tumor cannot be safely removed or its location prevents complete resection. The procedure helps in confirming the type of tumor, which is essential for planning effective treatment strategies. Dr. Cohen Gadol explains the use of imaging and a navigation system to ensure accuracy during the biopsy, and the difference between framed and frameless stereotactic biopsy systems.

05:00

🛠 Preparation and Procedure of Brain Biopsy

This paragraph details the preparation for a brain biopsy, including the cessation of blood thinners and non-steroidal anti-inflammatory drugs to minimize bleeding risks.术前检查和测试由内科医生执行，以确保患者能够承受麻醉。手术通常在全身麻醉下进行，过程相对简短，大约一小时。手术前夜，患者可能需要禁食以防止麻醉引起的呕吐或吸入性肺炎。患者可能被要求使用抗菌洗发水洗头。手术过程中，首先进行麻醉，然后在患者头部的特定区域剃除一小部分头发，并在固定装置的帮助下进行小切口，以确保患者头部在手术过程中保持不动。通过电脑系统和框架坐标的立体定向引导，医生能够实时追踪针头的位置，确保准确取得组织样本。取得样本后，会在手术室进行初步检查，并立即送往病理学家进行初步评估。如果样本可用，医生会取得额外的样本。最后，通过在颅骨上放置小金属板并用螺丝固定，以及用订书钉或缝线关闭皮肤，完成手术。患者醒来后会被转移到ICU或普通病房，并在恢复室进行监测。术后，患者可能会感到疼痛，但可以通过药物控制。几天后，患者需要遵循家中护理指南，通常住院一到两天，并可能进行CT扫描。

10:00

🏠 Post-Biopsy Care and Potential Complications

After the biopsy, patients are given instructions for post-operative care, including how to manage pain and incision site care. It is advised to avoid strenuous activities, alcohol, and nicotine products, and to gradually increase daily walks to promote recovery. Patients are encouraged to sleep with an elevated head and apply ice packs to reduce swelling. Dietary advice is also provided to combat constipation that may arise from anesthesia. The potential complications of the biopsy, while rare, are mainly related to bleeding in the brain, which can lead to new neurological symptoms. The procedure is considered very safe, with a 95% success rate, and most patients can return to normal activities within a week. Dr. Cohen Gadol emphasizes the importance of following the neurosurgeon's instructions and being vigilant for any signs of complications or adverse effects.

Keywords

💡Stereotactic brain biopsy

A stereotactic brain biopsy is a minimally invasive surgical procedure used to obtain a small sample of tissue from a brain tumor for further analysis. This procedure is crucial for diagnosing brain tumors, especially when complete surgical removal is not possible due to the tumor's location or size. In the script, it is mentioned as a method to confirm the type of tumor when surgery is not an option, allowing for alternative treatment plans.

💡Neurosurgeon

A neurosurgeon is a specialized medical doctor who performs surgeries on the brain and nervous system. In the context of the video, Dr. Aaron Cohengadoll, a neurosurgeon, is the one explaining the stereotactic brain biopsy process. He is the expert who would typically perform such a procedure, highlighting the importance of this role in managing brain tumors.

💡Brain tumor

A brain tumor refers to an abnormal growth of cells within the brain. It can be benign (non-cancerous) or malignant (cancerous). The script discusses the management of brain tumors, emphasizing the need for accurate diagnosis through biopsy when surgical removal is not feasible.

💡MRI

Magnetic Resonance Imaging (MRI) is a non-invasive diagnostic procedure that uses a magnetic field and radio waves to create detailed images of the brain. In the script, MRI is mentioned as the imaging technique used to identify brain tumors and guide the stereotactic biopsy procedure.

💡Pathologist

A pathologist is a medical doctor who specializes in the diagnosis of diseases through the examination of tissue samples. In the video, the pathologist's role is to analyze the tissue sample obtained from the brain biopsy to determine the exact type and aggressiveness of the tumor.

💡Coordinate-based navigation system

This refers to the technology used during a stereotactic biopsy to accurately locate the tumor within the brain. The system uses the patient's MRI or CT scans to guide the surgical instrument to the precise location of the tumor. The script explains that this system is crucial for the accuracy of the biopsy.

💡Frameless stereotactic procedure

A frameless stereotactic procedure is a method of performing a stereotactic biopsy without the need for a physical frame attached to the patient's head. The script mentions this as a more comfortable alternative to the traditional framed approach, using a GPS-like system for navigation.

💡Biopsy specimen

A biopsy specimen refers to the small piece of tissue that is removed during a biopsy for further examination. In the context of the video, the neurosurgeon obtains this specimen from the brain tumor to send to the pathologist for analysis, which is essential for confirming the diagnosis.

💡Neuropathologist

A neuropathologist is a specialized pathologist who focuses on the diagnosis of diseases affecting the nervous system. The script mentions that the biopsy specimen is sent to a neuropathologist for an initial evaluation and final diagnosis, emphasizing the importance of this role in the diagnostic process.

💡Post-biopsy care

Post-biopsy care refers to the instructions and actions taken after a biopsy procedure to ensure recovery and prevent complications. The script provides detailed post-biopsy care instructions, such as avoiding strenuous activities, proper incision care, and when to seek medical attention for potential complications.

💡Complications

Complications in the context of the video refer to potential adverse outcomes following a stereotactic brain biopsy, such as bleeding or infection. The script mentions that while the procedure is generally safe, complications can occur, and patients should be aware of the signs to report to their surgeon.

Highlights

Introduction of the speaker, Aaron Cohen Gadol, a neurosurgeon with extensive experience in brain tumor management.

Explanation of stereotactic brain biopsy, a procedure for obtaining tumor tissue for microscopic analysis.

Indication for stereotactic biopsy when a tumor cannot be safely removed or its location is inaccessible.

Definition of a brain biopsy and its purpose for tumor diagnosis confirmation.

The importance of microscopic analysis for accurate tumor diagnosis beyond imaging techniques.

Description of the stereotactic biopsy system using a coordinate-based navigation for accuracy.

Different types of stereotactic biopsy systems: framed and frameless procedures.

The role of the pathologist in examining the biopsy specimen for a definitive diagnosis.

Professionals involved in recommending and conducting a stereotactic brain biopsy.

Pre-biopsy procedures including stopping blood thinners and NSAIDs to minimize bleeding risks.

The process of anesthesia induction and patient preparation for the biopsy.

Detailed steps of the biopsy procedure, including incision, hole drilling, and needle advancement.

Immediate post-biopsy actions such as tissue sample checking and sending to the pathologist.

Post-surgery care including monitoring, pain management, and hospital stay.

Home care instructions and precautions after the biopsy procedure.

Potential complications of the biopsy, emphasizing the safety and rarity of serious issues.

Outcomes of brain biopsy, highlighting its effectiveness and minimal invasiveness.

Final remarks encouraging adherence to neurosurgeon's instructions and openness for questions.

Transcripts

hello ladies and gentlemen my name is

Aaron cohengadoll I'm a neurosurgeon

I've been involved with the management

of brain tumors

for many years and today I wanted to

talk to you about

the process and indication for

um stereotactic brain biopsy

and so this is one that can be a little

bit confusing

most often we remove a bit brain tumor

when it's diagnosed

as safely as possible however

there are times where a tumor cannot be

removed or its location would not make

it possible to be resected completely or

be even access safely in these

situations we want to at least confirm

what kind of tumor we're dealing with so

we can treat the tumor through other

means than surgery

so let's define what's a brain biopsy

it's a procedure to obtain a small piece

of tissue of the tumor from the brain

from further microscopic analysis

through the pathologist

to be able to see exactly what we're

dealing with because on MRI we see a

tumor it characteristics on Imaging can

tell us potentially what we're dealing

with but we can never be sure 100 until

we have a piece of tumor under the

microscope looking at it and confirming

it's

um it's real uh

diagnosis so what are the indications

for astrotactic biopsy it determines the

exact diagnosis as I mentioned of an

unidentified Mass found on Imaging most

often an MRI and we were able to

identify the type of the tumor and how

aggressive it is and based on these

characteristics we can

um design a treatment that's most

effective

it's a minimum minimally invasive

procedure it's performed with a

coordinate based navigation system in

other words it's a it's a computer

system in the operating room that would

allow us to localize any position on the

MRI to the position in the brain and

therefore we can be very accurate to get

the biopsy specimen from the location

within the tumor and not part of the

brain that's normal the system is

equipped with a patient MRI or CT scans

to guide the placement of the surgical

instrument or the needle to take the

biopsy

there are different types of stratactic

biopsy systems there's one that's framed

strategic biopsy which requires a frame

to be placed on the head of the patient

through small pins just just purchase

the outside of the skull bone this is

the most accurate method to uh be able

to Target a point in the brain of the

patient or it can be done frameless or a

frameless sister tactic procedure and no

frame is required during surgery so it's

more comfortable for the patient and um

it's a newer method it's a gps-like

system to navigate its accuracy is not

as perfectly as accurate to a frame a

strategic system or a frame extra tactic

system however it is accurate enough for

most lesions that are larger than a

certain size

so you may want to know who performs a

brain biopsy procedure the Strategic

brain biopsy involves the use of a

neurosurgeon with his or her expertise

to conduct the procedure after you see

an oncologist internal medicine doctor a

neurologist they may recommend a biopsy

or the neurosurgeon himself or herself

May advise that removal is unsafe we're

not sure what the tumor or other lesion

or mass in your brain is and therefore

we want to confirm the diagnosis

the procedure involves obtaining the

tissue specimen and the tissue specimen

sent to a physician called a pathologist

that specializes in the examination of

the tissue and final diagnosis

this specimen is as I said examined

carefully under microscope and the

report is sent back to the neurosurgeon

or any of your health care team to know

what the diagnosis is and what the

pathologist has found and then analyzing

the tissue on the microscope is really

the critical component of this process

especially knowing how aggressive the

tumors is it benign is it relatively

benign or is God forbid on unfortunately

aggressive or cancerous it may take up

to a week for the results of the biopsy

to come back so you have your procedure

you go home and get the results a week

later

so what happens before the biopsy so one

before one week before the surgery all

the blood thinners are stopped all the

non-steroidal anti-inflammatory drugs

are stopped so the risk of bleeding is

minimized several days before surgery

typically examination is done and other

tests may be performed by internal

medicine doctor to make sure you can

undergo anesthesia most often the biopsy

procedure is done with you under general

anesthesia and the length of the

procedure is relatively short under one

hour the night before the surgery your

phys physician may ask you to fast to

prevent vomiting while under anesthesia

or aspiration you may be asked to shower

with an antiseptic shampoo the night

before the procedure

so what happens during the biopsy one of

the steps involved

obviously induction of anesthesia so you

will not feel the pain and the patient's

head will be shaved in just a small area

and it can happen anywhere in the head

where this small incision is created

after the fixation device is applied to

the head of the patient so the head of

the patient does not move during the

surgery once the fixation device or the

clamp is in place that coordinates from

the MRI are registered to the head of

the patient when the register is

complete the needle can be moved and

tracked on the computer screen in real

time to see where the incision should be

made on the scalp so the second step is

incision and the bear hole small portion

of the patient hair as I said was shaved

at the beginning of the procedure the

scalp is incised one or two centimeter

in maximum length and a small

hole is created on the skull using a

medical drill to be able to pass the

needle through the brain to the Target

this small hole is called The Pearl

the needle is Advanced through the

computer system and the frame

coordinates

and strategic guidance and the surgeon

will be able to see where exactly they

are in the brain in real time to insert

the biopsy needle through the barrel

hole at the right appropriate length

angle and trajectory

the surgeon will then obtain the tissue

sample through the needle

next or step four this specimen

qualities checked in the operating room

while the patient is asleep the tissue

sample will be sent to the pathologist

or neuropathologist immediately for an

initial evaluation to ensure that the

tissue is usable and it's diagnostic if

the tissue sample is confirmed surgeon

will obtain a few additional samples to

send to the pathologist

the final step or step 5 involves

that once the sample is removed small

metal plate will be placed on the hole

in the skull with the screws to cover

the defect and the skin will be closed

with staples or stitches and bandages

will be applied and you will be awoken

from anesthesia and transfer to the ICU

or regular floor

so

immediately after surgery you're taken

to the recovery room for monitoring the

pain is common and is controlled with

medication several days after surgery

you have to have certain instructions to

take care of yourself at home but most

often the patients stay in the hospital

for one or two days in CT scan may be

performed

um so really the procedure requires an

overnight stay in the hospital

in at home police foreign instructions

provided by your surgeon you typically

can take a shower two days after the

procedure but do not brush over the

incision directly but you can brush

everywhere else and the incision can get

wet regarding your activities avoid

strenuous activities such as jogging

avoid risky behaviors do not drink

alcohol or use nicotine products try to

take walks five to ten minutes daily

frequently and increase the frequency

and the period of the walks gradually

try to sleep with the head elevated if

possible you may apply ice pack for 50

minutes to reduce pain and swelling to

the incision and try to drink water and

eat food high in fiber to resolve

constipation caused by the anesthesia

and narcotics

as I said about the incision care you

can shower about two days after surgery

wash gently the incision side with soap

and water daily avoid hair styling

product lotion or baths for at least a

month after surgery you can use

acetaminophenot Tylenol to control the

headaches

avoid the use of non-steroidal

anti-inflammatory medications such as

Advil and blood thinners for at least a

couple of days after the surgery but

please consult with your surgeon

if you have any fever chills confusion

headaches swelling bleeding or increased

pain morality incision site please

inform your surgeon right away

of course excessive sleepiness confusion

headaches weakness in arms and legs or

any other neurological symptoms should

be reported immediately what are the

complications from a brain biopsy

procedure

these procedures are extremely safe 95

percent safe but in less than five

percent of the time bleeding can occur

and can be significant the bleeding in

the brain can cause new neurological

symptoms

and

other medications obviously can have

side effects as well but the major

issue with biopsy procedure is bleeding

and the bearing but it occurs in a very

rare situation

the brain biopsy outcomes are usually

very favorable this is a minimally

invasive procedure in most cases

patients can return to normal activity

within a week reasonably well and at the

next visit was a very once in their

surgeon other questions can be answered

so overall it's a very minor procedure

in the overall on the mentorium of the

neurosurgeon it's very safe it's

effective over 95 percent of times a

very

realistic and

appropriate diagnosis can be achieved

and therefore please follow the

instructions of your neurosurgeons

regarding this procedure again thank you

for being with us today and feel free to

reach out to me if you have any

questions thank you